A Review of Ohio's Treatment Capacity in Addressing the State's Opiate Epidemic

Sherba, R. Thomas; Massatti, Rick R.; Potts, Laura; Adhikari, Surendra Bir; Martt, Nicholas; Starr, Sanford; Patel, Theresa Porter

doi:10.1515/1941-2851.1036

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…The increase in patients seeking treatment for opioid dependence challenges Ohio’s publicly-funded system of specialty addiction treatment providers. Ohio treatment providers report that opioid-dependent patients make up more than a quarter of all clients served, and nearly 80 percent of providers reported increased wait times for assessment services due to increased treatment demand [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…With the small number of methadone locations, methadone’s limited take-home availability, and the prevalence of opioid abuse, buprenorphine treatment is seen as a key strategy for reducing the adverse effects of opioid dependence in Ohio [ 24 ]. At present, 22% of Ohio treatment providers use buprenorphine to support recovery and 43% make referrals to physicians authorized to prescribed buprenorphine [ 23 ]. This is higher than the national buprenorphine use rate of 17% [ 7 ], but falls considerably short of 100% use.…”

Section: Introductionmentioning

confidence: 99%

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Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio

Molfenter

Sherbeck

Zehner

et al. 2015

Subst Abuse Treat Prev Policy

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BackgroundBuprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to enhance recovery. Their views could provide insights into the barriers and facilitators in buprenorphine adoption.MethodsWe conducted individual interviews with 18 Ohio county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards (payers) and 36 addiction treatment centers (providers) to examine barriers and facilitators to buprenorphine use. Transcripts were reviewed, coded, and qualitatively analyzed. First, we examined reasons that county boards supported buprenorphine use. A second analysis compared county boards and addiction treatment providers on perceived barriers and facilitators to buprenorphine use. The final analysis compared county boards with low and high use of buprenorphine to determine how facilitators and barriers differed between those settings.ResultsCounty boards (payers) promoted buprenorphine use to improve clinical care, reduce opioid overdose deaths, and prepare providers for participation in integrated models of health care delivery with primary care clinics and hospitals. Providers and payers shared many of the same perceptions of facilitators and barriers to buprenorphine use. Common facilitators identified were knowledge of buprenorphine benefits, funds allocated to purchase buprenorphine, and support from the criminal justice system. Common barriers were negative attitudes toward use of agonist pharmacotherapy, payment environment, and physician prescribing capacity. County boards with low buprenorphine use rates cited negative attitudes toward use of agonist medication as a primary barrier. County boards with high rates of buprenorphine use dedicated funds to purchase buprenorphine in spite of concerns about limited physician prescribing capacity.ConclusionsThis qualitative analysis found that attitudes toward use of medication and medication funding environment play important roles in an organization’s decision to begin buprenorphine use and that physician availability influences an organization’s ability to expand buprenorphine use over time.Additional education, reimbursement support, and policy changes are needed to support buprenorphine adoption and use, along with a greater understanding of the roles payers, providers, and regulators play in the adoption of targeted practices.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio

Molfenter

Sherbeck

Zehner

et al. 2015

Subst Abuse Treat Prev Policy

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“…Furthermore, while approval of buprenorphine (Suboxone ® ) extended maintenance treatment into general medical practices, many areas of the country have an insufficient number of willing providers, due to physicians’ concerns about induction logistics, reimbursement challenges, potential for medication diversion, lack of support for providers and lack of psychosocial services for patients (Barry et al, 2009; Becker & Fiellin, 2006; Kissin et al, 2006; Netherland et al, 2009; Sigmon, in press). The result is that many opioid-dependent individuals needing treatment can remain on waitlists for weeks or months, particularly those who must await admission to a subsidized program (Schwartz et al, 2009, 2011; Sherba et al, 2012). During this delay to treatment, they are at significant risk for continued illicit drug use, criminal activity, infectious disease, overdose and mortality (Adamson & Sellman, 1998; Clausen et al, 2009; Cooper, 1989; Darke & Hall, 2003; Schwartz et al, 2009; Warner-Smith et al, 2001; Wenger & Rosenbaum, 1994).…”

Section: Introductionmentioning

confidence: 99%

Interim treatment: Bridging delays to opioid treatment access

Sigmon

2015

Preventive Medicine

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Objective Despite the undisputed effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. To mitigate these risks, the Food and Drug Administration in 1993 approved interim treatment, involving daily medication + emergency counseling only, when only a waitlist is otherwise available. We review the published research in the 20 years since the approval of interim opioid treatment. Methods A literature search was conducted to identify all randomized trials evaluating the efficacy of interim treatment for opioid-dependent patients awaiting comprehensive treatment. Results Interim opioid treatment has been evaluated in four controlled trials to date. In three, interim treatment was compared to waitlist or placebo control conditions and produced greater outcomes on measures of illicit opioid use, retention, criminality and likelihood of entry into comprehensive treatment. In the fourth, interim treatment was compared to standard methadone maintenance and produced comparable outcomes in illicit opioid use, retention and criminal activity. Conclusions Interim treatment significantly reduces patient and societal risks when conventional treatment is unavailable. Further research is needed to examine the generality of these findings, further enhance outcomes, and identify the patient characteristics which predict treatment response.

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“…The rapid increase in opioid misuse creates an appropriate environment for use of evidence-based medication therapies to treat opioid addiction. Buprenorphine therapy is seen as a key strategy for reducing the adverse effects of opioid misuse in Ohio [22,23]. …”

Section: Methodsmentioning

confidence: 99%

Buprenorphine Prescribing Availability in a Sample of Ohio Specialty Treatment Organizations

Sherbeck¹

2015

J Addict Behav Ther Rehabil

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Objective Buprenorphine, a medication for treating opioid dependence, is underutilized in specialty addiction treatment organizations. Only physicians who have obtained a buprenorphine prescribing license or “waiver” may administer this medication. A limited number of physicians are pursuing this waiver, and a concern in the substance use disorder treatment field is that the shortage of prescribers could be contributing to the low use of buprenorphine at specialty addiction treatment centers. The objective of this study is to assess Ohio specialty treatment organizations’ access to buprenorphine prescribers and the barriers they encounter when seeking new physician prescribing capacity. Methods Forty-one Ohio specialty addiction treatment organizations were invited to complete a survey of their buprenorphine practices and availability of buprenorphine prescribers during August–October 2014. Data was collected on pharmacotherapies used in the treatment of opioid dependence, arrangements treatment organizations have with prescribing physicians, buprenorphine prescribing capacity, and barriers encountered in recruiting new physician prescribers. Results Thirty-seven treatment organizations responded, for a response rate of 90.2%. Seventy-eight percent (n=29) of the sample provided buprenorphine therapy. Of those treatment organizations, 48.3% (n=14) reported insufficient prescribing capacity. Of those, 50% (n=7) indicated they had to turn patients away from buprenorphine therapy due to limited physician prescribing capacity. Conclusion The study suggests that buprenorphine use is constrained by limited physician prescribing capacity, to the degree that 24.1% of the organizations surveyed using buprenorphine therapy had to turn patients away. Potential remedies include encouraging more specialty treatment organizations to have physicians on staff, removing the Drug Addiction Treatment Act (DATA 2000) cap that limits physician buprenorphine caseloads at 100 patients (after year 1), and developing strategies to recruit physicians into addiction treatment practice. Additional research is needed to increase the knowledge of physician prescribing capacity as a barrier to buprenorphine use, how to overcome these barriers, and to understand the extent physician capacity shortages are affecting buprenorphine use.

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A Review of Ohio's Treatment Capacity in Addressing the State's Opiate Epidemic

Cited by 5 publications

References 3 publications

Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio

Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio

Interim treatment: Bridging delays to opioid treatment access

Buprenorphine Prescribing Availability in a Sample of Ohio Specialty Treatment Organizations

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